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817-268-1992
817-268-1992

New Customer Information Sheet

New Customers need to fill out the form below to create an account.

Billing Information

Please select the account type:
Your Name
Your Company Name
Address
How Would You Like To Pay?

Shipping Information

Address
Do you require a reference on your invoice for each order?
Do you need an electronic proof of delivery?
Do you require a signed copy of your paperwork (BOL) included with your invoices?
There is 3% administrative fee for all accounts requiring any documentation other than electronic
Consent
I/We certify that all information on this form is correct. We fully understand your credit terms are due upon receipt and agree to the proper payment in consideration of extended credit.
MM slash DD slash YYYY
Clear Signature
5955 Eden Drive
Haltom City, TX 76117
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Company Info

phone

817-268-1992

email

flash@example.com

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